How Improved Population Health Can Lead to Better Care

During a session at Health Care Quality Congress 2018, David Nash, MD, MBA, dean of Jefferson College of Population Health at Thomas Jefferson University, discussed how managing population health can help improve health care quality.

Dr Nash began his session by explaining the issues currently facing health care to the audience.

“For the greatest nation on earth, that spends nearly $3 trillion on health care, 20% of the GDP, $10,000 per person—including children—on an annual basis … with all that wealth and all that treasure, what do we get,” Dr Nash asked, referencing a recent study.

“Well we are number 17 in world with the regard to the health of our population,” he said. “No other business, that I’m aware of would spend the most to get ranked 17th.”

According to Dr Nash, health care must reallocate, and the health care system faces tough decisions. He explained that, from a population health perspective, the average annual life span is actually moving backwards.

“The average annual life span in our country is in reverse gear, for the first time ever,” he stressed. “Due, in no small part, to the deaths of despair—alcoholism, drug abuse, and depression.”

Despite the current life span reversal that has been reported, Dr Nash said that only a small number of Americans who receive appropriate care on prevention.

Referencing a Health Affairs study, Dr Nash said, “Few Americans receive all the high-value, appropriate care on prevention because the money isn’t doing the procedures.”

Dr Nash then explained that the conceptual framework of population health is influenced by health outcomes, health determinants and policies and interventions. Among health outcomes and their distribution within a population, morbidity, mortality, and quality of life of a patient are impacted. Further, according to Dr Nash, health determinants that influence distribution—including smoking, unhealthy diet, physical inactivity, and alcohol, which account for roughly 40% of all deaths—impact medical care, socioeconomics and genetics. Finally, policies and interventions that impact health determinants impact social, environmental and individual aspects of a patient.  

According to Dr Nash the US currently spends 2% of health care spending on population health. He explained, however, that chronic disease, which equals 80% of total disease burden, has no dedicated federal funding stream.

“So what is the message—we’ve got to change the education process to create the doctor, pharmacist and nurse of the future because this is what their core competency is all about.”

“Now look,” he continued, “every system is designed to achieve the results it gets. So if you get 2% funding from the population health, it is going to take a while and that is part of the challenge.”

So what does all this mean, asked Dr Nash. He explained that the major themes moving forward include transparency, accountability, and no outcome, no income.

Dr Nash said in order to meet these themes, the health care system must change the culture. He explained that this is a multistep process. Included in Dr Nash’s process is:

• Practice based evidence;
• Reduce unexplained clinical variation;
• Reducing slavish adherence to professional autonomy;
• Continuously measure and close feedback loop; and,
• Engage with patients across the continuum of care.  

He stressed that there needs to be a push in nutritional health during medical school for doctors, nurses and pharmacists in order to improve the culture. He said that there must be a change to the education process to create the doctor, nurses, pharmacists of the future because this is what their core competency is all about. Further, he explained that many leaders in health care did not have this nutritional training.

“My personal view is … it’s all in the right direction,” he said. “I know, the only way you’re going to change clinician behavior is to realign the economic incentives.”

“I’m optimistic about the future,” Dr Nash said.

—Julie Gould